Comparative clinical outcomes in children with Febrile Infection-Related Epilepsy Syndrome (FIRES)

Jia Hui Teo; Wai Chen Lim; Mae Shyan Wong; Jeremy B Lin; Velda X Han; Zhi Min Ng; Terrence Thomas

doi:10.1016/j.yebeh.2025.110467

Comparative clinical outcomes in children with Febrile Infection-Related Epilepsy Syndrome (FIRES)

Epilepsy Behav. 2025 Sep:170:110467. doi: 10.1016/j.yebeh.2025.110467. Epub 2025 May 17.

Authors

Jia Hui Teo¹, Wai Chen Lim², Mae Shyan Wong³, Jeremy B Lin⁴, Velda X Han², Zhi Min Ng⁵, Terrence Thomas⁵

Affiliations

¹ Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore. Electronic address: teo.jia.hui@singhealth.com.sg.
² Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
³ Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
⁴ Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵ Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.

PMID: 40382999
DOI: 10.1016/j.yebeh.2025.110467

Abstract

Background and aims: We evaluated functional, emotional, and behavioural outcomes in children with FIRES in those who received only conventional treatments versus those who received biologics and/or ketogenic diet.

Methods: A retrospective chart review of children (<18 years) diagnosed with FIRES at two paediatric hospitals. Children were analysed according to two time periods according to availability of biologics (from 2018 onwards). Functional outcomes were assessed via modified Rankin Scale (mRS) and paediatric functional independence measure (WeeFIM). Aggression symptoms (screened with modified overt aggression scale (MOAS)), diagnoses of attention deficit/ hyperactivity disorder (ADHD), and anxiety and depression were also recorded. These outcome measures were analysed in intervals, up to 24 months post diagnosis.

Results: There were 30 children (mean age 8.9 ± 4.2 years) diagnosed with FIRES. Median mRS at 12 months post FIRES was 2 (IQR 1-5). WeeFIM score was lower at discharge (p = 0.053) to 24 months follow up (p = 0.030) in children who required biologics and/or KD. Aggression was more prevalent (53.5 %) in the latter period (2018-2023) with median MOAS scores higher at discharge (p = 0.019) and follow up at 24 months (p = 0.10). Inattention (33.3 %) and mood disorders (20 %) were observed in similar proportions of children across both time periods. Aggression appeared earlier (median 1.8 months, IQR 1-4.5) whilst inattention and mood disorder were noted later (median 4 months, IQR 1.8-10.5 and median 27 months, IQR 12 = 39 respectively).

Conclusion: All children recovering from FIRES need to be screened for potential long-term emotional and behavioural sequelae.

What this paper adds: (1) Behavioural and emotional sequelae were observed in FIRES regardless of whether biologics and/or Ketogenic Diet treatment was given. (2) Aggression symptoms appeared earlier, whilst inattention and mood disorder were noted later during follow up. (3) All children post FIRES should be screened for long-term emotional and behavioural sequelae.

Keywords: Neurorehabilitation; Outcomes; Paediatric neurology; Refractory epilepsy.

Publication types

Comparative Study

MeSH terms

Adolescent
Aggression / physiology
Attention Deficit Disorder with Hyperactivity
Child
Child, Preschool
Diet, Ketogenic
Epileptic Syndromes*
Female
Fever* / complications
Humans
Male
Retrospective Studies
Seizures, Febrile* / complications
Seizures, Febrile* / psychology
Treatment Outcome